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flu already claimed the lives of a 28-year-old man and a 45-year-old
man, both from Lehigh County.
The above comments confirm the H1N1 death cluster at Lehigh Valley Hospital. Initial media reports noted the first death was on November 19 of a previously healthy young adult. A second previously healthy young adult was on a ventilator at the same hospital and the PADOH November 22 health advisory cited one death and an outbreak of severe illness associated with H1N1 in the Lehigh Valley. The week 46 flu report from Pennsylvania, released on November 24 cited two flu deaths in week 46 (out of three confirmed cases for the entire season in Lehigh). Thus, the two cases (45M and 28M) were clustered in time and space and died at the same hospital.
The last such cluster was at the Duke Medical Center where 3 of 4 H1N1 patients died within a few days of each other. The index case had D225G, while a second death had D225N. It is likely that all four cases had both changes because all had the rare polymorphism Y223H in HA as well as H274Y in NA and all four patients were on the same floor and two were in adjacent rooms.
The new cluster is a reminder that declarations of an end of the pandemic phase do not change the target population of H1N1, who are under 65. Over 90% of H1N1 deaths were under 65, while over 90% of H3N2 fatalities are over 65.
In addition to the death cluster in Lehigh Valley, the most recent reported trH3N2 case is also from Pennsylvania. It is very closely related to the case from Wisconsin, supporting human transmission of trH3N2. Four of the five trH3N2 cases reported in the US are closely related to each other, and internal genes are related to human H1 cases in Ohio, Illinois, and Michigan linked to fairs in August, 2007.